States focus on doctor arrangements with imaging centers

The efforts were spurred by a report concluding that some relationships are illegal or need more regulation.

By Amy Lynn Sorrel, AMNews staff. Aug. 7, 2006.

Several states are strengthening self-referral and anti-kickback statutes to curb what they see as illegal physician referrals to imaging centers and potentially unnecessary scans. Their efforts come in response to a March 2005 congressional advisory panel report that pointed out weaknesses in federal law governing "self-referrals."

Federal rules provide a range of safe harbors allowing physicians, under limited circumstances, to refer patients to centers in which they have a financial interest. But the Medicare Payment Advisory Commission concluded that a variety of leasing, employment or compensation deals are either illegal or need to be further regulated to prevent "financial incentives that may improperly influence physicians' professional judgment."

If left unchecked, these arrangements could lead to inappropriate testing, which would hurt the quality of patient care and increase health care costs, the panel warned in its report to Congress.

A June report by the Health and Human Services Office of Inspector General estimated that the Centers for Medicare & Medicaid Services paid a handful of imaging facilities $71.5 million for services that "were not always reasonable and necessary" or did not comply with federal law.

Doctors using the safe harbors view them as a way to offer patients more choice in where to get tested. Physicians who don't follow the rules face harsh penalties, ranging from getting kicked out of Medicare or Medicaid to losing their state medical licenses. The MedPAC report has increased federal and state scrutiny of these arrangements.